Provider’s Views On The Psychosocial
Factors That Influence Risk Behavior Among
Young Black Men Who Have Sex With Men
Michael Leonardo Foster, EdD
Susan Kegeles, PhD
Gregory Rebchook, PhD
Center for AIDS Prevention Studies
University of California San Francisco
Funded By:
Universitywide AIDS Research Program
National Institutes of Health
Aims of This Research

To explore the perceptions of
Community-Based Organization
(CBO) providers about three
prominent psychosocial factors that
influence self-concept and HIV risk
behavior among young Black MSM
Overview

Background

Methods

Three Psychosocial Barriers To Safer Sex

Where Do We Go From Here?
Background
Over-representation of Black AIDS cases
Non-existence of evidence-based, culturally
appropriate community-level HIV/AIDS
prevention interventions
Research Questions
*What factors do you think place young Black MSM at
risk for contracting HIV?
*How does religion influence sexual risk-taking among
young Black MSM?
*How do you think the influence of family affects
sexual risk taking behavior among young Black
MSM?
*What do you think the relationship is between SES and
risk-taking behavior for young Black MSM?
Methods

21 front-line CBO employees (mostly program
coordinators) recruited

Interviewed for 90-120 minutes

Topics: attitudes about fit between evidence-based
HIV/AIDS prevention models and clients’ needs;
experience implementing evidence-based programs
with clients, and psychosocial factors that influence
sexual risk behaviors among young Black MSM
Data Analysis

Extensive notes were taken during telephone
interviews

Comments were recorded verbatim, whenever
possible

Data were coded thematically and validated
with other members of research team
Three Psychosocial Barriers to Safer Sex

Shame-filled Religiosity

Familial Stigmatization and Rejection

Sexual-Economic Asymmetrical DecisionMaking
Shame-filled Religiosity (18)
I think that religion in Black communities contributes
to homophobia. And then, I think that homophobia
contributes to shame and that affects how people
negotiate sex. If someone is ashamed, they are
more likely to seek secretive sex…Do we talk about
using condoms?…or talk about how to make not
using condoms safer? Those conversations don’t
take place and that all contributes to how people
are having sex.
Shame-filled Religiosity (continued)
Religion does influence them. Religion tells them they
are an abomination before God. It all ties into selfesteem. As long as church teaches HIV as
punishment for gayness, these negative messages will
continue to affect the self-esteem of young Black
MSM and then their low self-esteem will orient them
to value their own lives less and take more risks.
Through homophobia, people hide their sexuality.
When you do anything in the dark, everything is
rushed and there is not time for safety talks and
condom negotiation.
Shame-filled Religiosity (continued)
Religion instills more shame and fear about their sexual
being; that they are defying God and are going to be
punished. Therefore, why would you want to be open
and discuss your sexual business with someone who
is already condemning you. I can see homophobia
making it more difficult to have conservations with
people, like pastors, who should be compassionate.
What you’re getting instead is that you’re unworthy
and not loved by God. They become closeted. They
might not see the necessity to protect themselves and
may think that their lives are not worth it,
subconsciously.
Familial Stigmatization and Rejection (21)
You see lots of times when young Black MSM
come out, their families shut them away and
they look for love elsewhere. Once they get
ostracized, they are more likely to take risks to
get that love.
Familial Stigmatization and Rejection
(continued)
If the family is not accepting, not embracing,
young African American MSM are going to
take their behavior underground. There is not
going to be the development of a loving
relationship with another man because they
would have to disclose the relationship to their
family.
Familial Stigmatization and Rejection
(continued)
We have learned from a young age that
homosexuality is taboo. You couldn’t open up
to your family and ask questions. Basically,
people learn as they play. As a result, lots of
stuff we do is secretive and full of risk —
taking place at night or in the dark. And then,
when you haven’t learned to communicate with
your family, this inability also translates over
into communication with sexual partners about
sexual practices.
Sexual-Economic Asymmetrical DecisionMaking (16)
Sometimes men enter into relationships that are
unhealthy. The person with the money is able to
wield control…If I am driving his car and eating his
food, sometimes people in those situations feel like
they have to do whatever they are asked to do. I
know people who are in situations like that who were
asked to be in threesomes and foursomes. This
person is what stands between you and a park
bench…
Sexual-Economic Asymmetrical
Decision-Making (continued)
Lots of young guys don’t have money and they
find older guys with money who give them
money and they take more (sexual) risks with
that person. The older person may be
requiring that they have unsafe sex. The young
guys feel like they have to do it because that is
where the money is coming from.
Sexual-Economic Asymmetrical
Decision-Making (continued)
…[E]specially with young Black MSM, if I am
bombarded with images that say this is what I am
suppose to have, and everyone I see in the media has
cars, bling bling, but I don’t have the resources to
acquire them myself, that is going to encourage me to
be involved with someone who has the resources…I
am not going to demand the use of condoms with
someone who has what I want. I am not going to
broach the subject if it means that I am going to ruin
my set-up by saying that we need to talk about HIV
and safe sex. If I bring it up, he’s going to think I am
HIV-positive and I am not going to risk that…I hear
many young Black MSM say that I want a rich man. I
don’t hear many say that I want to be a rich man
myself.
Where Do We Go From Here?
Recommendations



Shame-filled Religiosity: Broaden the options for
worship to include gay-positive, Open and Affirming
churches
Familial Stigmatization and Rejection: Establish
supportive communities of young Black MSM to
work on healing from emotional scars from church
and familial stigmatization and rejection. Also focus
on acquiring skills to discuss sexual safety issues
Sexual-Economic Asymmetrical Decision-making:
Provide holistic support for young Black MSM,
including job training and skills building components
to enhance their financial prospects
Contact Information
Michael Leonardo Foster
Center for AIDS Prevention Studies (CAPS)
University of California San Francisco
Telephone: (415) 597-8123
Email address: Michael.Foster@ucsf.edu